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The wet starch obtained from these processes is dried and milled before use in pharmaceutical formulations. The site and depth of infiltrating implants often correlate with bowel pain (8) and lower urinary tract dysfunction and pain. Medical treatment of reflux is reserved for individuals with excessive emesis episodes, irritability related to gastroesophageal reflux, failure to thrive, or recurrent respiratory symptoms. Glyceryl trinitrite has been found quite effective when administered through this route. Thus, solubility can be achieved as long as the formulation pH is at least three units away from the pKa. For example, insulin exhibits a differing degree of activity depending on its state. After making this general statement, although the examiners will still probably wish to discuss the various surgical options available, they will generally make allowances if you do not know them in particularly great detail; in reality you have covered yourself beforehand. Increase in temperature generally increases Brownian motion of dispersed phase particles. In addition to the effects of the menstrual cycle on the perception of pain in healthy individuals, sex hormones have been implicated in pain sensitivity among women diagnosed with a prior pain disorder. Protein and Peptide Drug Delivery 403 noncovalent interactions of "distant" amino acids, which gives the overall structure to one polypeptide chain called the tertiary structure. Non Specific and Global Treatments When a specific diagnosis is not possible or when the target treatment is failed, it is suggested to move toward non specific and global interventions for pain relief. Painful calluses under the metatarsal heads caused by forefoot plantarflexion and fixed toe deformity. The incorporation of insoluble compounds within micelles of the surfactants in an aqueous solution can solubilize these insoluble drugs. The maximum force of contraction of the affected muscle is decreased, with muscle weakness and increased fatigability, but without atrophy or muscle fibrosis. Make sure the tape measure is easy to carry about, neat if the foldaway variety and make sure it is long enough. The interconversions between these units and their relationship to the metric system are as follows: 1 gal = 4 qt = 3785 mL 1 qt = 2 pt = 946 mL 1 pt = 16 oz = 473 mL 1 oz = 30 mL (more accurately, 29. Classification Many classifications are descriptive and give information about the site of the fracture but are of little value in formulating a strategy for management. You are likely to get one of these topics in either the short or intermediate cases. Tumour biology Concepts of tumour growth3 the compression zone/pseudocapsule: tumours grow in a centrifugal fashion, leading to compression and then atrophy of the normal surrounding tissue Reactive zone: surrounding the pseudocapsule is an area of oedema and neovascularity characterized by the presence of inflammatory cells and micronodules of tumour 283 Section 4: the adult elective orthopaedics oral Table 18. The examiner scoring me did not seem to really take much interest and I thought at this stage he had decided whether I had passed or failed. Injectable suspensions often consist of the active ingredient suspended in an aqueous vehicle containing an antimicrobial preservative, a surfactant, a suspending agent, a buffer, and/or a salt. There is also a deep slip, which is attached to the medial lip of a groove on the trapezium. Surgical complications: Bleeding, bruising, infections, surgical wound dehiscence, cyst in the Bartholin glands, weakness of anal sphincter, vaginismus, vaginal stenosis, lubrification decreased and recurrent pain. The involvement of the periurethral smooth muscle cells, the anterior fibromuscolar stroma, and the bladder neck muscle fibers, which are anatomically contiguous and compose the preprostatic sphincter (Villers et al, 1990). Their branch-like structure leads to spheres which in higher generations appear to be the size of micelles and ultimately nanospheres of small dimensions. There is a Z-deformity of the thumb, swan-neck deformity of the left little and ring fingers. Identify situations in which the use of hard or soft gelatin capsules may be preferred over tablets 5. In the past year there has been a marked deterioration in her pain such that she now wishes to be considered for surgery. Deep transverse perineal muscle Location: Dorsal part of the urogenital diaphragm.

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There is a flexion deformity at the knee produced by muscle imbalance between the hamstrings and the quadriceps. The concentration of tissue metabolites release in the ischemic process may cause irritation and is the origin of pelvic pain. Surgical Causes of compression the causes of compression are numerous and include: Tumours, ganglion, lipoma (soft-tissue masses) Thrombosis/pseudoaneurysm of the ulnar artery Pisiform instability Pisotriquetral arthritis Fractures distal to the radius/ulnar, hook of hamate, pisiform Palmaris brevis hypertrophy Muscle anomalies. A change in the solvent medium can result in a different, lower, thermodynamically least free energy state of protein conformation. Enteric coated tablets are compressed tablets coated with substances that are insoluble in the low pH environment of the stomach, but dissolve readily on passage in to the small intestine with its elevated pH. There is no Achilles tendon tightness, and there are otherwise normal ankle and subtalar movements. Hormonal substances, such as thyroid extract, insulin, and pituitary hormones obtained from the endocrine glands of cattle, sheep, and swine, are life-saving drugs used daily as replacement therapy. This in fact can be quite a common scenario and can cause extreme distress to candidates. Studies suggest that estrogen affects sensory discrimination and pain sensitivity at multiple sites within the central and peripheral nervous systems and, possibly, alter innervation of estrogen responsive targets (138). The micelles are in dynamic equilibrium with free molecules (monomers) in solution; that is, the micelles are continuously breaking down and reforming. Technological advantage such as good content uniformity of a lowdose drug or formulation of a water-insoluble drug that is liquid at room temperature. Congenital kyphosis and kyphoscoliosis are much less common than either idiopathic or congenital scoliosis. In case of atropine, below pH 3, the main reaction is hydrogen ion catalyzed hydrolysis of the protonated form of atropine. Posteromedial tibial bowing is seen shortly after birth and it is very unlikely to be shown in the clinical section; however, it may appear in the oral section as a picture of a newly born baby with classical bowing. The reason why each and every value in the data set is not the expected value is considered to be due to random variation or errors in experimentation or data collection. The excipients could be vehicles, cosolvents, buffers, preservatives, antioxidants, inert gases, surfactants, complexation agents, and chelating agents. Atlas (C1) fractures Injury to C1 is associated with other injuries in 50% of cases. Biodegradable polymer breaks down in to metabolic products by hydrolysis or enzymatic action. Thus, cyclodextrins can form reversible water-soluble inclusion or occlusion complexes of hydrophobic compounds. Most protein and peptide drugs are susceptible to rapid degradation by digestive enzymes. Grade A: Medullary canal completely filled with cement (whiteout) with no distinguishable border between the cement and the bone Grade B: Near complete filling. Future Prespectives Central Role, Newer Markers, Genetics and Multi-Disciplinary Treatment There are many new promising areas in which future research would be probably rewarding: Recent evolving aetiological model includes a peripheral initiating event in the genetically anatomically/physiologically susceptible patient. Pentosan polysulfate sodium therapy for men with chronic pelvic pain syndrome: a multicenter, randomized, placebo controlled study. It has been attributed to changes in estrogen concentration, embryologic abnormalities, increased urinary oxalates, and immune factors. Removal may require withdrawing, as a unit, the telescopic forceps and bronchoscope. Concerns with transmission of infection from donor to recipient have led to irradiation of bone allograft as a means of sterilization. Monomer and oligomer: Polymers are synthesized from simple molecules called monomers by a process called polymerization. For example, in a solution of silver iodide with excess [I-], the silver iodide particles carry a negative charge; however, the charge is positive if excess [Ag+] is present. Examination corner Adult and pathology 1: Acute lumbar disc prolapse Diagnosis Management Indications for surgery Approach Complications. There has been disagreement between the various supporters of each theory but it would appear that some wrists function more like rows and others more like columns.

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Differential diagnosis My differential diagnosis would include: Pigmented villonodular synovitis (giant cell tumour tendon sheath) Epidermal inclusion cyst Neurilemmoma Fibroma of tendon sheath Foreign body granuloma Xanthoma tuberosum Digital lipoma. Asked what I would advise her about the outcome, I mentioned that there was a good 47 Section 3: the clinicals likelihood of early night-pain relief but numbness could take up to 1 year to settle and the wasting would be permanent. The condition predisposes to osteoarthritis of the ulnohumeral joint in later life. Concentration of solute or diffusant, C, in the volume of the region, x, changes as a result of net flow of diffusing molecules in or out of the region. It is a test of time management, examination technique and English language comprehension as much as a test of orthopaedic knowledge and clinical judgement. All series have highlighted the greater risk of revision compared with that in older and/or less active populations. Therefore, a powder bed consisting of very fine particles, even though they may possess a narrow size distribution, tends to have flow problems compared to a similar powder bed of coarse particles. Were there any postoperative complications such as wound infection or washout or need for antibiotics Look for evidence of repetitive impingement demonstrated by radiographic signs of repetitive bone-to-component abutments such as a depression in the neck or a contour just below the junction with the component (divot sign) often associated with a reactive exostosis. The swelling is probably bony in origin and very suggestive of pseudoarthrosis of the clavicle. Most feel that this structure can be adequately decompressed with a smaller incision using scissors and retractors to protect the median nerve. This phenomenon can be explained by the pH-partition theory, which states that drugs are absorbed from biological membranes by passive diffusion depending on the fraction of the un-ionized form of the drug at the pH of that biological membrane. The variables in this experiment are commonly termed as "factors" and the experiment as a "factorial experiment. Relative contraindications: Lengthy warm ischaemia time Elderly with microvascular disease Uncooperative patient. Drain through a vertical midline incision distal to the skin crease, taking care to break down all containing septa. Solitary osteochondromas They usually present as a painless, slow-growing swelling in children or adolescents, mostly around the knee. These include, for example, herbal and other natural products such as laxatives and nutraceuticals, and dusting powders intended for external, local application. Anionic surfactants have high hydrophilicity and can be used as detergents, foaming agents, and in shampoos. Positioning in flexion, patience and application of warm saline usually return the perfusion. The application of vacuum inside the rollers and/or forced filling of the components enables formation of cavity. Adsorption of a solute on a solid surface leads to a monolayer formation as the solute occupies available surface. The buccal mucosa has an expanse of smooth muscle and relatively immobile mucosa which makes it a more desirable region for retentive systems used for oral transmucosal drug delivery. They asked me to comment on the subchondral collapse and what treatment I would have started at that stage. Depending on the design of the granulator, wet granulation could impart low or high levels of shear to the powder blend and is termed accordingly. Leukaemia Haematopoietic disease widely affecting the bone marrow Bone pain is present in 25% of children and 5% of adults with the disease but radiographic changes are present in up to 90% X-rays show: 1. Insertions: Outside in to the posterior surface of the ischial pubic ramus; inside in to the anterior part of the median perineal aponeurosis. Different surgical treatments have been described, including decompression and posterolateral fusion, repair with Scott wiring or Buck screw fixation. If these contractions come to dilate cervical canal can move fibroid in to the vagina (fibroid delivery). Surgery is indicated if there are significant symptoms and deformity such as toes underriding adjacent medial toes.

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For example, milling of a drug substance with needle-shaped crystals results in smaller, irregular shaped crystals that are closer to the spherical geometry. These membrane systems contain a reservoir, which is in contact with the inner surface of the rate-controlling membrane. Types of suppository base: Oleaginous bases Water-soluble or water-miscible suppository bases 21. For example, I-vation intravitreal implant is made of a nonferrous metal alloy, designed to be placed inside the vitreous humor of the eye using a 25 gauge needle stick. Avascular structure Concentric rings of fibrocartilaginous tissue Layers cross each other obliquely. The drug release rate is dependent on the surface area and nature of the membrane, and the diameter of the hole. Enhanced synthesis of proinflammatory cytokines by vulvar vestibular fibroblasts: implications for vulvar vestibulitis. Since the 1960s of the previous century world literature has been familiar with processes from the so-called ultra-sound chemistry, which forces the catalytic disintegration of rings in aromatic compounds, or the separation of functional groups blocking for instance the biological activity of a drug. The standard understanding of pain generation in neurovertebral conflicts, where only the mechanical factor is taken in to consideration, is still prevalent among many doctors [43]. Arginine, histidine, and lysine contain basic ionizable side chains and are referred to as the basic amino acids. Classification (Wassel) Based on the complete or incomplete duplication of each phalanx: 1. Technique the patient is placed supine with their head slightly extended (roll under shoulders). Capsular fibrosis is one of the most serious complications associated with silicone breast implants. The appearance of turbidity at the cloud point is due to separation of the solution in to two phases. Small lesions confined to the medial anterosuperior portion of the femoral head tend not to collapse. Deep Infiltrating Endometriosis of the Recto-Vaginal Septum the occurrence of deep infiltrating endometriosis of the recotvaginal septum, especially with bowel and /or vaginal infiltration, is related to the severity of dysmenorrhea. I went for epithelioid sarcoma and ended up in a difficult discussion until the bell went. Endometriosis-Associated Smooth Muscle Cells In addition to epithelial and stromal cells, smooth muscle cells are also found in peritoneal endometriotic lesions (Mechsner et al. A diffuse form of giant cell tumour not seen in the hand that occurs in areas adjacent to large weightbearing joints. You might be shown one of the braces as a talking point so try to be aware of the types in common use. The treatment of ovarian vein thrombosis is anticoagulation and administration of parenteral antibiotics. Instrumentation is associated with higher fusion rates and, in younger patients with higher demands, may theoretically help prevent progression of the slip. Thus, if the tableting operation is performing at target, then there is a 19% chance that the sample mean would fall below 90 based on a sample of 10 tablets. Many drug substances can exist in more than one crystalline form, with different lattice arrangements. In the electrophonophoresis method the surface of the skin is affected by an electric current gradient, which supplies the dissociated ionic particles with a kinematic stimulus Local Use of Electrophonophoresis in the Treatment of Patients. Formulation considerations for suppository manufacturing include a careful consideration of density, since suppository molds are volume filled while the formulation composition are weight based. Glycosaminoglycans in normal human urine act as long-term crystal growth inhibitors. Finally, we do not have to forget that this kind of pain is chronic, so it is important to ensure these patients a point of reference that provides an appropriate follow-up and eventually solutions for any problems or a confirmation about the success of therapy.

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Tennis elbow (lateral epicondylitis) Typically a short case in which the candidate would be asked to demonstrate provocative tests for tennis elbow. The V-40 neck and titanium-molybdenum-zirconiumiron stem are particularly prone to cause squeaking. In these studies, two or more drug products are administered after encapsulating them in hard gelatin capsules of same specifications and such that the capsules cannot be opened. If the foreign body is removed easily without mucosal trauma, the child can be extubated and discharged from the recovery room if he is able to take adequate oral intake. Application of ice packs or cold for local pain control (for periods of more than 20 minutes each time) or baths, wear loose clothing and underwear cotton 100%. This is a conventional technique that involves mass fractionation of a powder sample on a set of sieves of defined pore diameter using mechanical vibration. However, the use of Span 20 + Span 80 is expected to give a more stable emulsion than Span 60 in the same quantities. The outline of the articular ends of the bone becomes irregular because of destruction by the disease process. Did he have surgery, was he admitted to hospital at any time, did he use an ambulation abduction brace, etc. Volar subluxation and supination of the carpus occurs due to laxity of the strong extrinsic volar carpal ligaments. For example, given that the freezing point of blood serum and ophthalmic lachrymal fluid is -0. Also, certain drugs such as penicillin G and erythromycin are unstable in gastric fluids and do not readily dissolve in them. The flat or convex radial head and flat capitellum make relocation very difficult If necessary, excision of the radial head in the adult can be done to relieve pain and improve appearance; however, the range of motion is not significantly altered. Edema of the supraglottic structures worsens symptoms of laryngomalacia, increasing the degree of airway collapse and increasing work associated with breathing. One of these limitations is that about one-third use custom self-report measures which have not been standardized. Comment on knees and feet position when the patient is sitting; sometimes it is very clear that one side is shorter. Other differential diagnoses include cervical radiculopathy at C5/6, compression of the upper trunk brachial plexus and proximal median nerve compression. The examiner felt that he/she had given a very poor reply with no proper structure or order to the question. Tendon ruptures Distal biceps rupture A predisposing factor for rupture is degeneration in the hypovascular zone close to the radial tuberosity insertion. It is a continuous probability distribution and forms a typical bell shaped curve. Conversely, the lower the solubility of the solute in the solvent, the higher its extent of adsorption on to the solid adsorbent. These microbeads are next treated with polylysine solution which displaces the surface layer of calcium ions and forms a permanent polysalt shell or membrane. The rigidity and permeability of the bilayer strongly depend on the type and quality of lipids used. In addition, there are several restrictions on the kinds of drugs and formulations that can be encapsulated. Abduction is corrected by tilting the pelvis downwards and scoliosis of the lumbar spine with convexity towards the affected side. The syndrome is closely related to among others lifestyle, diet, smoking, sexual dysfunction, and anorectal disorders. After obtaining desired droplet size and emulsion stability, the system is stirred at constant rate followed by solvent evaporation using a rotary evaporator.

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Double curves may have a less obvious contralateral loin hump where the lumbar curve goes the opposite way to the thoracic curve. Neurological problems around the shoulder Suprascapular nerve (C5, C6) this comes off the upper trunk (C5, C6) of the brachial plexus and runs through the suprascapular notch to supply supraspinatus and then enters the spinoglenoid notch to supply infraspinatus. Carpal height ratio Carpal height ratio equals the carpal height divided by the length of the third metacarpal, and is usually between 0. One line is drawn from the anterior superior iliac spine to the centre of the acetabular socket. The main disadvantage is that the mobile head articulates directly with acetabular bone and can cause pain and medial bone erosion. The ligament is stretched rather than ruptured and this often results in a secondary adduction contracture of the web space. The aim of surgery is to achieve a pain-free, plantigrade, supple but stable foot. Types of shoulder arthroplasty For balanced (stable anteroposteriorly) and compensated (by deltoid) shoulder: Surface hemi and total arthroplasty Stemmed hemi and total arthroplasty. It is produced by irreversible, partial hydrolysis of collagen, which is obtained from animal skin and bones. Despite numerous studies, considerable controversy remains regarding the incidence, pathogenesis, natural history, and optimal treatment of this disorder. For example, there is an increase in solubilizing capacity of a series of polysorbates for selected barbiturates as the alkyl chain length is increased from C12 (polysorbate 20) to C18 (polysorbate 80). Macrocystic lesions, especially those in the posterior neck, may be observed and even spontaneously regress. As a consequence, the fascia and muscle shorten and ache, and generate in an area of the muscle a taut band within which there is a hyperirritable point, the so-called "Trigger Point". Parkes-Weber Syndrome Parkes-Weber syndrome is a high-flow lesion that consists of a capillaryarterial-venous malformation. Numerous dosage forms are administered through this route of administration, including solutions (aqueous or oily based), emulsions (o/w or w/o), suspensions (aqueous or oily based), colloidal suspensions, and reconstitutable powders. These include the use of drug eluting stents for the prevention of in-stent restenosis (fibrosis and thrombus-induced blockade of the stented artery). There are firm subcutaneous nodules at the elbow, over the extensor tendons and in the palm. This is a spot diagnosis that you really must be able to recognize without any prompting from the examiners. Suspending drugs in nonaqueous solvents such as alcohol, glycerin, or propylene glycol may also reduce hydrolysis. This phenomenon is known as solubilization and the incorporated substance is referred to as the solubilizate. It is a vertical to slightly oblique discrete white cortical line and forms the straight line of the teardrop. Unless this skill has been practised beforehand, it is impossible to arrive at a set of questions which is reasonable, sensible and, most importantly, structured. This phenomenon is used to concentrate dilute solutions of proteins and to separate a mixture of proteins. Additives present in capsule formulations, such as the amount and choice of fillers, lubricants, disintegrants, and surfactants, and the degree of plug compaction, can influence drug release from the capsule. Myofascial Pain Syndrome of the Pelvic Wall Muscles Causes: inflammation, acute or repeated trauma, exposure to cold and other stressors can trigger muscle pathogenic mechanisms, which give rise to the fascia, muscle and sometimes containing other flexible and elastic tissues neighbors lose their elasticity this fascia and muscle shortening and pain, resulting in a zone, a taut band within which houses a hyperirritable point, the so-called "trigger points". Advantages: No scar tissue, therefore making for an easier dissection Demarcation where the nerve needs resection Able to define the injury at an early stage Early repair results in a better outcome. Normally when performing carpal tunnel decompression I extend the skin incision slightly above the distal wrist crease. Soft-tissue balance in these patients is extremely difficult and therefore dislocation rates are high. Delayed union and non-union have been reported, though some series report 100% fusion rates. These nuclear medicine scans are not recommended for routine evaluation of patients suspected of gastroesophageal reflux.

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Joint arthroplasty:82 joint arthroplasty is not performed in the active stage and should only be considered after a safe period of absolute disease quiescence. Candidate debriefing the candidate gave a slightly substandard answer albeit by no means a disastrous one. Salvage If definitive treatment fails the following salvage operations may be required. Radioisotope bone scan is sensitive and shows increased focal uptake, though this is not specific. People with chronic pain use a high number of health care resources such emergency, diagnostics and outpatient services and generate a high cost of prescriptions for analgesia and anti-inflammatory drugs. Assess your own strengths and weaknesses; if you are lacking experience in a particular subspecialty, attend clinics in those areas and enrol on specific courses. Estrous changes in responses of rat gracile nucleus neurons to stimulation of skin and pelvic viscera. Hypotonic solutions, on the other hand, can provide excess fluid to the body tissues. Microcystic lesions can be treated with sclerosing agents with a complete response rate of 14% and partial response rate of 50%. Dorsal extensor compartments of the wrist (six) There are fibro-osseous tunnels through which the extensor tendons pass and are numbered from radial to ulnar. Surgery may be indicated in the rare cases of: A severe restriction of hip range of motion Severe pain from impingement. Most patients do not need any surgical intervention; however, patients with recurrent or permanent patellar dislocation should be treated with surgical stabilization. However, it is suggested that such children be examined by an otolaryngologist every 3 to 4 months, under sedation if necessary, to avoid lengthy delays in diagnosis. Do sensory calcitonin gene-related peptide nerve fibres in the rat pelvic plexus supply autonomic neurons projecting to the uterus and cervix Bladder defense molecules, urothelial differentiation, urinary biomarkers, and interstitial cystitis. It is less reliable than percutaneous epiphysiodesis, growth may not be retarded immediately and uneven inhibition may lead to condylar deformity. These differences often reflect in the melting point of various crystalline forms. These plastic changes may alter pain perception in a variable way and cause pain by nonpainful stimuli (allodynia); the pain can also be spontaneous, intensify (hyperalgesia), extend, or increase in duration, thus contributing to the worsening of the initial disease [11]. Electrotherapy are other possibilities of treatment, in turn, transvaginal electrostimulation has been associated with a success rate of 50%, approximately. Surgical treatment Surgical resection of tumour may be aimed at improving survival (resection) or palliating symptoms by decompressing neural structures and stabilizing the spine. Laser diffraction analysis is based on the size dependence of scattering of incident laser light by particulates in the sample. On the other hand, if the sample of 10 tablets had a standard deviation of 15 mg, the t-score would be 2. Preliminaries Introduce yourself to the patient Ask permission to examine the hip Ask if their hip is painful Explain to the patient that you are going to be moving them about and will do your best not to hurt them Make sure that you watch their face throughout the examination and avoid sudden movements Tell the examiner that you would like to start by undressing the patient to his/her underwear, including removing socks. Some drugs which are poorly soluble in water may be dissolved in a mixture of water and alcohol or glycerol solvents. This may be all that the examiners are looking for, namely that you are willing to refer on complex cases out of your area of expertise rather than take on a case you are not experienced enough in dealing with. Tight junctions can block the passage of even relatively small molecules, whereas gap junctions are looser and molecules up to 1200 Da can pass freely between cells. It is suggested as a more durable procedure than an arthroplasty and restricts motion less than an arthroplasty, but has not gained widespread popularity A variety of surgical options exist and none is clearly superior. Arthroscopy allows the assessment of: Cartilage surfaces Synovium Intrinsic and extrinsic ligaments Relative stability/motion of the carpal bones to each other Presence of anomalous structures, entrapped or mechanically interfering tissues, scar and/or other blocking tissue. Increased rates of community-acquired pneumonia, gastroenteritis, and Candida infections have been associated with prolonged use of proton pump inhibitors. The midfoot can be stabilized and the tarsometatarsal joint moved in a combined fashion and then individually.

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Difficult to describe as not the classic gait described of shortened stance phase and prolonged swing phase A gait dysrhythmia owing to a slower gait velocity with a shortened step length, a greater than normal anterior pelvic tilt and lumbar lordosis. Discussion focused mainly on the differentiating features of neurogenic versus spinal claudication. This is worse in patients anxious and nervous; when they move their bodies, the electrodes lose contact with the skin. The watersoluble base can solubilize water-soluble drugs and some water-insoluble drugs. There are several schools of thought in respect of timing of orthopaedic interventions. Depending on the functional groups and relative surface areas of the two regions, surfactants could have a range of hydrophilic/ hydrophobic properties. Arthrogram (what to look for) An arthrogram is a useful investigative tool in a problem hip. Microemulsions can be used to increase the bioavailability of poorly water soluble drugs by incorporating them in to the oily phase. Charged surfactants can further help an increase in negative or positive zeta potential and will thus help to maintain stability by increasing or decreasing electrostatic repulsive forces and facilitating flocculation. If you have left things late, then concentrate on the common topics first and finish with the rare. Correlation is greatest in groups D1 and D2, weaker in groups C1, C2 and B1,B2 and weakest in groups A1 and A2 (table 4). Similar to ppm, it is dimensionless and does not represent a state (solid or liquid) of the substance. At an extreme pH and temperature, the peptide bond can undergo rapid proteolysis resulting in protein degradation and/or fragmentation. Other features on clinical examination include decreased chest expansion and a decreased range of spinal movement. The limits of the web space are the natatory ligaments distally, the deep attachment of the palmar fascia proximally and its attachment to the tendon sheath laterally. Examination corner Hand oral 1 Early versus late exploration of brachial plexus injuries Advantages and disadvantages of each Current literature on the subject. Reactions can be zero (indicating independence to reactant concentrations), first (indicating that reaction rate is proportional to the first power of one of the reactants), second (indicating that reaction rate is proportional to the first power of two of the reactants or the second power of one of the reactants), or higher order. Complications Chondrolysis: rapid progressive loss of articular cartilage associated with pin penetration of the joint and multiple screw fixation. Some examiners are now asking about this classification system rather than the better known Ficat or Steinberg system. Inflammation of the pelvic organs: prostatitis, cystitis, urethritis, endometriosis, vaginitis, proctitis, hemorrhoids, or anal fissures Pain referred from other muscle groups, viscera, or nerves. The popliteofibular ligament acts as a primary restraint to external rotation of the tibia on the femur at 30 of flexion. They are usually asymptomatic but if they are large size may show with compressive symptoms of close organs. The presence of neuropathic signs and symptoms in segments or branches of the pudendal nerve identifiy the damaged nerve pathway, all these manifestation are called: perineodynia, urethrodynia, vestibulodynia or vulvodynia.